National Institute for Health and Clinical Excellence (NICE)
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Selective laser therapy recommended to treat glaucoma and ocular hypertension

People newly diagnosed with glaucoma and ocular hypertension (OHT) should initially be offered selective laser therapy (SLT) treatment rather than eye drops, according to an updated NICE guideline published today (Wednesday, 26 January)

The recommended changes in clinical practice will reduce the number of patients needing eye drops and make savings for the NHS.

NICE’s latest guideline on the diagnosis and management of glaucoma looked at the treatment and organisation of care for ocular hypertension (OHT) and chronic open angle glaucoma (COAG).

Glaucoma is a group of eye conditions where the optic nerve becomes damaged, resulting in sight loss. It’s one of the most common causes of blindness worldwide.

Around 10 per cent of people in the UK who go blind do so due to glaucoma.

An increase in pressure within the eye, also called ocular hypertension, is a major risk factor for developing COAG. Controlling this inner eye pressure is the main way of preventing COAG.

In the UK chronic open angle glaucoma affects around 2% of people aged over 40 years and can rise to almost 10% in people aged over 75. Ocular hypertension affects 3–5% of people in the UK over 40 years of age.

The change in approach to treatment would see an increase in routine use of selective laser therapy (SLT), a procedure where a laser is applied through a contact lens to reduce intraocular pressure (IOP) in patients. The increased use of this treatment would reduce the use of eye drops and potentially decrease the need for some patients to undergo cataract or intraocular pressure lowering surgery.

The reduced use of eye drops, and cataract or intraocular lowering surgery, would more than cover the costs of introducing SLT more widely, including training staff and purchasing the equipment.

It is estimated implementing this guideline for England in the next five years would result in a saving of around £87,500 in 2021/22, rising to around £400,000 by 2025/26.

Healthcare professionals should refer people who are suitable for selective laser therapy to a consultant ophthalmologist and discuss with them the decision to offer SLT and how it will be performed. Healthcare professionals undertaking SLT should be given support by the responsible consultant ophthalmologist and have relevant training.

Dr Paul Chrisp, Director for Centre for Guidelines at NICE, said: “Chronic open angle glaucoma is a serious condition, and our updated guideline will allow people who suffer from it, or ocular hypertension, to quickly receive effective treatment to improve their quality of life.

“Usually, eye drops are initially prescribed to lower the pressure in the eye. However, the evidence showed that first-line treatment with selective laser therapy is more cost effective than eye drops.

“The guideline has been developed following a public consultation last year and we are recommending that local healthcare services carrying out laser therapy should be providing their staff with training on the treatment. It is crucial that healthcare professionals discuss the benefits and risks with patients, family members and carers to agree on a treatment plan for each person.”

NICE also highlighted there was a lack of long-term evidence on progression of glaucoma and optic nerve damage and has recommended that further research is carried out into this area.

Further information on the glaucoma guideline, including information for the public, is available on the NICE website.

The guideline aims to reduce health inequalities, it is recognised that using eye drops is harder for certain groups, including people with cognitive and physical impairments and people with learning disabilities.

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